The short-term outcomes of Ivor Lewis esophagectomy versus McKeown esophagectomy for thoracic middle-lower esophageal carcinoma: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZUO Jiebin ^1,2 , QU Wendong ¹ , ZHOU Aiming ^1,2 , ZHOU Jianguo ³ ,  SONG Yongxiang ¹ ,  XU Gang ¹

1. Department of Thoracic Surgery, Affliated Hospital of Zunyi Medical College, Zunyi, 563000, Guizhou, P.R.China;
2. Zunyi Medical College of Medicine, Zunyi, 563000, Guizhou, P.R.China;
3. Department of Oncology, Affliated Hospital of Zunyi Medical College, Zunyi, 563000, Guizhou, P.R.China;

Corresponding author：

SONG Yongxiang, Email: songtang2004@163.com; XU Gang, Email: xglhl333@163.com

Keywords：

Thoracic middle-lower esophageal carcinoma; minimally invasive esophagectomy; Ivor Lewis approach; McKeown approach; meta-analysis

DOI：

10.7507/1007-4848.201608067

Video：

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ObjectiveTo compare the short-term outcomes between Ivor Lewis esophagectomy and McKeown esophagectomy under thoracoscopy and laparoscopy for thoracic middle-lower esophageal carcinoma and to investigate the optimal approach.MethodsThe relevant literatures (from database foundation to March 2016) comparing minimally invasive Ivor Lewis esophagectomy and minimally invasive McKeown esophagectomy were searched through PubMed, EMbase, The Cochrane Library, CBM, CNKI, Wanfang Data and VIP. RevMan 5.3 software was used for data analysis.ResultsA total of 870 patients in 5 studies were reviewed and data were pooled for analysis. The score of Newcastle Ottawa for the literatures was 7-8 points. The results showed that compared with the McKeown group, Ivor Lewis group had shorter operation time (WMD=–34.67, 95% CI –53.70 to –15.65, P=0.000 4), less recurrent laryngeal nerve injuries (OR=0.23, 95% CI 0.12 to 0.44, P<0.000 01), anastomotic leakage (OR=0.24, 95% CI 0.14 to 0.41, P<0.000 01), anastomotic stenosis (OR=0.30, 95% CI 0.16 to 0.55, P=0.000 01), and pulmonary complications ( OR=0.25, 95% CI 0.15 to 0.43, P<0.000 01). There was no significant difference between the two groups in intraoperative blood loss, postoperative stay, hospitalization cost and chylothorax incidence. The McKeown group was associated with much more lymph nodes dissection (WMD=–1.16, 95% CI –2.00 to –0.31,P=0.007) than the Ivor Lewis group.ConclusionCompared with McKeown esophagectomy combined with thoracoscopy and laparoscopy, Ivor Lewis esophagectomy combined with thoracoscopy and laparoscopy has some advantages for thoracic middle-lower esophageal carcinoma, but a greater number of lymph nodes are dissected in McKeown procedure.

Citation： ZUO Jiebin, QU Wendong, ZHOU Aiming, ZHOU Jianguo, SONG Yongxiang, XU Gang. The short-term outcomes of Ivor Lewis esophagectomy versus McKeown esophagectomy for thoracic middle-lower esophageal carcinoma: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(6): 456-462. doi: 10.7507/1007-4848.201608067 Copy

1.	Pennathur A, Gibson MK, Jobe BA, et al. Oesophageal carcinoma. S Afi Med J, 1981, 47(47): 348-351.
2.	Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med, 2003, 349(23): 2241-2252.
3.	毛友生, 赫捷, 高树庚, 等. 我国食管癌外科治疗目前存在的热点争议与未来研究方向. 中华胃肠外科杂志, 2015,18(9): 851-854.
4.	Pennathur A, Luketich JD. Resection for esophageal cancer: strategies for optimal management. Ann Thorac Surg, 2008, 85(2): S751-S756.
5.	Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Int J Surg, 2009, 7(9): 889-896.
6.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
7.	孟庆江. 微创 McKeown 与 Ivor-Lewis 手术治疗中下段食管癌临床分析. 中国医学创新, 2016, 13(1): 17-20.
8.	梅闪闪, 刘继先, 吴昊, 等. 微创荷包钳法 Ivor-Lewis 术与 McKeown 术治疗中下段食管癌的近期疗效分析. 重庆医科大学学报, 2016, 41(1): 89-93.
9.	Zhai C, Liu Y, Li W, et al. A comparison of short-term outcomes between Ivor-Lewis and McKeown minimally invasive esophagectomy. J Thorac Dis, 2016, 7(12): 2352-2358.
10.	吴汉然, 解明然, 柳常青, 等. 微创 Ivor-Lewis 术与 McKeown 术治疗胸中下段食管癌近期疗效比较. 中华胸心血管外科杂志, 2014, 30(11): 649-652.
11.	林济红, 康明强, 林江波, 等. 胸腹腔镜联合食管癌 Ivor-Lewis 术与 McKeown 术近期疗效比较. 中华胃肠外科杂志, 2014, 17(9): 888-891.
12.	Maas KW, Cuesta MA, Henegouwen MIVB, et al. Quality of life and late complications after minimally invasive compared to open esophagectomy: Results of a randomized trial. World J Surg, 2015, 39(8): 1-8.
13.	Zhang ZM, Wang Y, Gao YS, et al. Minimally invasive esophagectomy for esophageal carcinoma: clinical analysis of 160 cases. Zhonghua Wei Chang Wai Ke Za Zhi, 2012, 15(9): 934-937.
14.	Mei X, Xu M, Guo M, et al. Minimally invasive Ivor-Lewis oesophagectomy is a feasible and safe approach for patients with oesophageal cancer. ANZ J Surg, 2016, 86(4): 274.
15.	Smithers BM, Gotley DC, Martin I, et al. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg, 2007, 247(2): 397-398.
16.	Wang W, Zhou Y, Feng J, et al. Oncological and surgical outcomes of minimally invasive versus open esophagectomy for esophageal squamous cell carcinoma: a matched-pair comparative study. Int J Clin Exp Med, 2015, 8(9): 15983-15990.
17.	Yang J, Lyu B, Zhu W, et al. A retrospective cohort comparison of esophageal carcinoma between thoracoscopic and laparoscopic esophagectomy and open esophagectomy. Zhonghua Wai Ke Za Zhi, 2015, 53(5): 378-381.
18.	Zhu Z, Chen H, Yu W, et al. Number of negative lymph nodes is associated with survival in thoracic esophageal squamous cell carcinoma patients undergoing three-field lymphadenectomy. Ann Surg Oncol, 2014, 21(9): 2857-2863.
19.	Alline M, Bertrand MM, Colombo PE, et al. Lymph node dissection: what for? From esophagus to rectum: surgical and lymph node related prognostic factors. Bull Cancer, 2014, 101(4): 368-372.
20.	Ye T, Sun Y, Zhang Y, et al. Three-field or two-field resection for thoracic esophageal cancer: a meta-analysis. Ann Thorac Surg, 2013, 96(6): 1933-1941.
21.	Hsu PK, Huang CS, Wang BY, et al. The prognostic value of the number of negative lymph nodes in esophageal cancer patients after transthoracic resection. Ann Thorac Surg, 2013, 96(3): 995-1001.
22.	Baba Y, Watanabe M, Shigaki H, et al. Negative lymph-node count is associated with survival in patients with resected esophageal squamous cell carcinoma. Surgery, 2013, 153(2): 234-241.
23.	Peyre CG, Hagen JA, Demeester SR, et al. The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg, 2008, 248(4): 549-556.
24.	Butler N, Collins S, Memon B, et al. Minimally invasive oesophagectomy: current status and future direction. Surg Endosc, 2011, 25(7): 2071-2083.
25.	Nakata K, Nagai E, Ohuchida K, et al. Outcomes of cervical end-to-side triangulating esophagogastric anastomosis with minimally invasive esophagectomy. World J Surg, 2015, 39(5): 1099-1104.
26.	Zhou C, Ma G, Li X, et al. Is minimally invasive esophagectomy effective for preventing anastomotic leakages after esophagectomy for cancer? A systematic review and meta-analysis. World J Surg Oncol, 2015, 13(1): 1-10.

1. Pennathur A, Gibson MK, Jobe BA, et al. Oesophageal carcinoma. S Afi Med J, 1981, 47(47): 348-351.
2. Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med, 2003, 349(23): 2241-2252.
3. 毛友生, 赫捷, 高树庚, 等. 我国食管癌外科治疗目前存在的热点争议与未来研究方向. 中华胃肠外科杂志, 2015,18(9): 851-854.
4. Pennathur A, Luketich JD. Resection for esophageal cancer: strategies for optimal management. Ann Thorac Surg, 2008, 85(2): S751-S756.
5. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Int J Surg, 2009, 7(9): 889-896.
6. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
7. 孟庆江. 微创 McKeown 与 Ivor-Lewis 手术治疗中下段食管癌临床分析. 中国医学创新, 2016, 13(1): 17-20.
8. 梅闪闪, 刘继先, 吴昊, 等. 微创荷包钳法 Ivor-Lewis 术与 McKeown 术治疗中下段食管癌的近期疗效分析. 重庆医科大学学报, 2016, 41(1): 89-93.
9. Zhai C, Liu Y, Li W, et al. A comparison of short-term outcomes between Ivor-Lewis and McKeown minimally invasive esophagectomy. J Thorac Dis, 2016, 7(12): 2352-2358.
10. 吴汉然, 解明然, 柳常青, 等. 微创 Ivor-Lewis 术与 McKeown 术治疗胸中下段食管癌近期疗效比较. 中华胸心血管外科杂志, 2014, 30(11): 649-652.
11. 林济红, 康明强, 林江波, 等. 胸腹腔镜联合食管癌 Ivor-Lewis 术与 McKeown 术近期疗效比较. 中华胃肠外科杂志, 2014, 17(9): 888-891.
12. Maas KW, Cuesta MA, Henegouwen MIVB, et al. Quality of life and late complications after minimally invasive compared to open esophagectomy: Results of a randomized trial. World J Surg, 2015, 39(8): 1-8.
13. Zhang ZM, Wang Y, Gao YS, et al. Minimally invasive esophagectomy for esophageal carcinoma: clinical analysis of 160 cases. Zhonghua Wei Chang Wai Ke Za Zhi, 2012, 15(9): 934-937.
14. Mei X, Xu M, Guo M, et al. Minimally invasive Ivor-Lewis oesophagectomy is a feasible and safe approach for patients with oesophageal cancer. ANZ J Surg, 2016, 86(4): 274.
15. Smithers BM, Gotley DC, Martin I, et al. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg, 2007, 247(2): 397-398.
16. Wang W, Zhou Y, Feng J, et al. Oncological and surgical outcomes of minimally invasive versus open esophagectomy for esophageal squamous cell carcinoma: a matched-pair comparative study. Int J Clin Exp Med, 2015, 8(9): 15983-15990.
17. Yang J, Lyu B, Zhu W, et al. A retrospective cohort comparison of esophageal carcinoma between thoracoscopic and laparoscopic esophagectomy and open esophagectomy. Zhonghua Wai Ke Za Zhi, 2015, 53(5): 378-381.
18. Zhu Z, Chen H, Yu W, et al. Number of negative lymph nodes is associated with survival in thoracic esophageal squamous cell carcinoma patients undergoing three-field lymphadenectomy. Ann Surg Oncol, 2014, 21(9): 2857-2863.
19. Alline M, Bertrand MM, Colombo PE, et al. Lymph node dissection: what for? From esophagus to rectum: surgical and lymph node related prognostic factors. Bull Cancer, 2014, 101(4): 368-372.
20. Ye T, Sun Y, Zhang Y, et al. Three-field or two-field resection for thoracic esophageal cancer: a meta-analysis. Ann Thorac Surg, 2013, 96(6): 1933-1941.
21. Hsu PK, Huang CS, Wang BY, et al. The prognostic value of the number of negative lymph nodes in esophageal cancer patients after transthoracic resection. Ann Thorac Surg, 2013, 96(3): 995-1001.
22. Baba Y, Watanabe M, Shigaki H, et al. Negative lymph-node count is associated with survival in patients with resected esophageal squamous cell carcinoma. Surgery, 2013, 153(2): 234-241.
23. Peyre CG, Hagen JA, Demeester SR, et al. The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg, 2008, 248(4): 549-556.
24. Butler N, Collins S, Memon B, et al. Minimally invasive oesophagectomy: current status and future direction. Surg Endosc, 2011, 25(7): 2071-2083.
25. Nakata K, Nagai E, Ohuchida K, et al. Outcomes of cervical end-to-side triangulating esophagogastric anastomosis with minimally invasive esophagectomy. World J Surg, 2015, 39(5): 1099-1104.
26. Zhou C, Ma G, Li X, et al. Is minimally invasive esophagectomy effective for preventing anastomotic leakages after esophagectomy for cancer? A systematic review and meta-analysis. World J Surg Oncol, 2015, 13(1): 1-10.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The short-term outcomes of Ivor Lewis esophagectomy versus McKeown esophagectomy for thoracic middle-lower esophageal carcinoma: A systematic review and meta-analysis

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